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Republicans in Arizona Are at Odds on Medicaid

PHOENIX — For Gov. Jan Brewer, the passage last month of a Medicaid expansion was a major coup. Despite a Republican majority in the Legislature, where she faced significant opposition from Tea Party members, she rallied the entire Democratic delegation to her side and made a progressive issue palatable to just enough conservatives, casting the expansion as the right decision for the state, morally and monetarily.

“It’s pro-life, it’s saving lives, it is creating jobs, it is saving hospitals,” Ms. Brewer said in an interview from her office in the Capitol’s executive tower, where she conducts what she often describes as “the people’s business.”

“I don’t know how you can get any more conservative than that,” she said.

A lot of conservatives disagree. Ms. Brewer’s maneuvering, including a threat to veto any bill brought before her until the expansion was voted on and a last-minute call for a legislative special session to force the vote, has sparked ire among the Republican rank and file. In interviews, many of its most loyal members conceded that the party’s once cohesive ideology has been tainted by the governor’s stance, and they are arming themselves for payback.

Name-calling, once reserved for closed-door encounters and precinct committee meetings, has seeped into the public debate, loudly. One conservative blog, Sonoran Alliance, has taken to describing the Republican legislators who voted for the expansion as “Brewercrats” and the expansion itself as “Obrewercare,” a play on the Republican moniker for President Obama’s health care overhaul.

A. J. LaFaro, the chairman of the Maricopa County Republican Committee, compared the governor to Judas during a hearing in the State House of Representatives. In a blog post by FreedomWorks, a libertarian group, Tyler S. Boyer, a district chairman, characterized the tactics that Ms. Brewer used to push through the expansion as “an unfortunate display of moral ineptitude.”

“Reagan once said Republicans shouldn’t speak ill of one another,” said Shawnna L. M. Bolick, a conservative who began exploring a run for a legislative seat after her district’s Republican state representative and senator voted to expand Medicaid. “I’ve had a very hard time keeping my mouth shut.”

Volunteers have eight more weeks to finish the job of collecting signatures to put the Medicaid expansion on the ballot, with the hope that voters will undo what Ms. Brewer fought so hard to get approved. That is happening despite the fact that voters agreed, in 1996 and in 2000, to extend Medicaid coverage to childless adults, one of the main beneficiaries of expansion.

“She abandoned the planks of the Republican Party platform to do whatever she perceived to be popular, and she grossly miscalculated the power we had to fight back,” said Frank Antenori, a former Republican state senator from Tucson and one of the forces behind the initiative.

Volunteers must gather 86,400 valid signatures to put the question to voters. Mr. Antenori said they were collecting, on average, 1,300 signatures a day.

Meanwhile, inside and outside the Capitol, Ms. Brewer’s team has been building its defenses. This month, it hired circulators to get people to sign a petition in support of the Medicaid expansion, an effort that has been largely bankrolled by the same business and health care groups that financed the campaign to guarantee its passage through the Legislature. The groups have also committed to help the Republican lawmakers who stood by Ms. Brewer fend off primary challengers who plan to use Medicaid to draw disaffected voters to the polls.

“The thing to keep in mind is that the Republican primary voter is much more conservative than the Republican general-election voter,” said Barrett Marson, a public relations consultant who works on Republican campaigns. “There’s no doubt 2014 is going to mark the end of some careers in the Legislature for the people who lent their support to Medicaid expansion.”

The governor said she would use money raised by her political action committee to aid Republican incumbents who supported her, but also to fight against those who strongly opposed her.

She also signed a piece of legislation, pushed primarily by the Arizona Chamber of Commerce, that significantly raised the limits for contributions to political campaigns.

Chuck Coughlin, a political consultant who managed Ms. Brewer’s transition team and remains a very close ally, said the “loosening of the spigot is going to do a tremendous service for that part of our party, pro-business and pro-job growth, to exercise their will in the elections.” (The law is being challenged on the basis that it undermines the state’s public campaign financing program, which voters enacted to limit the influence of money in politics.)

“Ideologues have their agendas,” said Mr. Coughlin, who orchestrated the push to get the Medicaid expansion through the Legislature, “and the part of the party that’s taking issue with the governor right now is all made up of ideologues.”

The strategy, he explained, is to expand the universe of voters that moderate Republican candidates can reach by expanding the means by which their message is delivered. Instead of knocking on doors, as Tea Party volunteers have successfully done to get like-minded voters to the polls, there will be more ads, more phone calls and more events targeting specific groups of people, like women and independents, “always a big swing vote in any election,” he said.

Bruce Merrill, a political behaviorist who is a senior research fellow at the Morrison Institute for Public Policy at Arizona State University, said that in the end, the reaction over Medicaid was prime evidence of “how truly fractured the Republican Party in Arizona is.”

For people like Ms. Bolick, the potential legislative candidate, and Hugh Hallman, who is running for governor on the Republican ticket, the real battle is over principle: what is the right role for the federal government in people’s lives? Both are self-described fiscal conservatives, but they differ on Medicaid expansion.

Ms. Bolick, a public policy analyst who worked for Rick Santorum during his time in the Senate and Rick Perry when he was lieutenant governor in Texas, is against it. Mr. Hallman, a former mayor and city councilman in Tempe, supports it.

“The real brilliance of Barack Obama when he made Medicaid an all-or-nothing proposition,” giving states no option but to cover individuals with incomes up to 133 percent of the federal poverty line if they were to qualify for federal reimbursement, “was that he pitted fiscally conservative Republicans against one another,” he said.

Ms. Brewer, in the interview, chalked it up to bruised egos, something that time and pep talks could easily resolve.

“Nobody likes to lose, and that’s what happened” the night the Medicaid expansion got past the Legislature, she said. “I believe we will heal.”

Rebekah Zemansky contributed reporting.

A version of this article appears in print on July 22, 2013, on page A10 of the New York edition with the headline: Republicans In Arizona Are at Odds On Medicaid. Order Reprints|Today's Paper|Subscribe